Best approach for recovering ED person?

I figure it's best to be really honest here. I am trying to recover from unhealthy eating patterns. Mostly binge eating, sometimes anorexic eating, and a history/tendency of purging (that part's pretty rare now, but still runs through my head as an option I try to avoid)

I am in treatment, but at the moment, I'm not scheduled very often (I guess they feel I'm well enough to try this on my own now - but I'm still in the system and have a nurse and dietician and people to talk to if I need help)

I mean, most of my symptoms had stopped last year once I gave up wheat. Now, they're pretty bad again. I can't stop eating things like cheese, processed gluten free things, and sugary things. It's terrible.

My ideas of treatment clash with the ideas of the professionals in the program. They want me to eat pretty much everything, like a SAD diet with everything in moderation. I can't do that. I have tried, but it's been like an alcoholic having a sample of alcohol every day and then trying to stop! It's ridiculous. I remember what it was like eating no sugar or wheat, and it was so different - no cravings, no "eating to stuff my feelings" because those feelings I had only happened to exist once I started eating the unhealthy stuff in the first place!

My problem now, is where to go from here.

I want to try either paleo or perfect health diet. I want to be able to get well.

I don't know how to go about transitioning to this. I feel like I can't do it all at once. I cut out wheat last october, though I still have trace amounts in things I'm sure. But it was a huge change, and took awhile to get used to. So I'm looking for the best changes to make next, that are small enough to handle. I feel like I need to take this in steps, for my own sanity.

Which is better for me, paleo or phd?

What change do I make first? Cut out cheese? (I believe it's causing incredible cravings in me - every time I have it I seem to not be able to stop eating all the things ever) Or cut out grains? (I don't have wheat, but other grains, yes) Or cut out legumes? If I'm to take this slowly, what do I do first?

When I'm able to eat this way (paleo/phd/whatever) how do I explain it to family? (I'm done trying to explain it to professionals). I don't want them to see it as disordered eating. For once in my life, I'm trying to do what is healthy for me and have a healthy relationship with food. Say I go have a meal with my family, and my mum wants to make me my own little one with rice noodles and tons of cheese, but I prefer to bring my own dish that has neither of those. She will see it as restricting disordered eating... but in my mind, I'm trying to do what's best and recover. I don't know what to do about this problem.

Will eating this way help me to eventually lose weight? I do have a lot of weight to lose, and I want to lose it. However, the part of my brain that tells me I'm full is very broken right now. I've tried primal in the past (like with cheese and things like that) and I never lost weight and always over ate everything, all the time. I'm hoping if I eat this way that it will help my hunger signals. But I'm so weary about that now - do you think it can actually help me lose weight and stop over eating?

I just feel so sad and discouraged right now. I hate struggling with this. I've worked on the emotional side of things, but it appears that the physical part (cravings and things) are quite strong. It's also hard to practice this way of eating when society is against it, and my friends and family aren't really for it, AND I have cravings to eat those SAD things too!! It feels like I'm going against so much. Other people here seem to have no problem with eating this way, but for me, I CRAVE things like McDonalds and pizza and pasta and desserts. I love it all (though am against McDonalds for ethical reasons as well as health reasons!)

Do you think that I can ever do this? Am I resigned to always struggle with craving all the things and being overweight and a slave to food? I want to change but every step seems momentous and like society, friends, family, and my own body are fighting against it. :(

You may find that low-carb is best for you ultimately, at least when trying to lose significant weight. But with an active ED I think it's dangerous to jump into any sort of extreme, restrictive, challenging new diet.

Starches without much added salt, fat, sweet and/or 'crunch' don't seem to induce binge behavior for most people who struggle with it. :) Trial and error, though. If you find a certain food is causing you to overindulge, you know it's not worth keeping around. I'd stick to unsweetened/high protein varieties of yogurt. Since you would like to lose weight, do not pour cream and butter on everything, but I don't see why you shouldn't use them in recipes. Cooking every day is a really great way to get into a healthy, normal pattern with food.

(Ah, weight training and body vitality can truly make a very large difference, even on an unclean-diet. (From reading some other comments, seems like an interesting thing to explore/do meanwhile while sorting out diet/health.))

As a side note -- many people seem to find that true ferments speed gut health recovery tremeendously.
There are a few investigations into the effectiveness of probiotic supplements which show that many are at least somewhat ineffective, and even a high-quality probiotic is far from the organisms/cm3 in a true ferment (if I recall not incorrectly, this is around 1 billion + : 2-4 million; ferments : supplements.)

Low-carb and not low-carb seems very...fluid, but if it's doable, you might try PHD, or sushi/white rice if low-carb paleo all at once is untenable for any number of reasons. Sushi rice might be less provocative than oats/grains. And, you can also transition to lower carb Paleo from PHD slowly, or experimentally. Feet-first low-carb is another possibly beneficial experiment if your gut health really is being negatively affected by carbs, but only so long as it is tenable, or has a fallback, such as PHD.

Kim chi and other fermented foods will all have beneficial bacteria/enzymes so long as they're unpasteurized (Pasteurization supposedly kills all beneficial bacteria and destroys many beneficial enzymes and digestively helpful constituents). Best if they contain the "mother". Many commercial preparations pasteurize kimchi(though this is much more commonly raw than other foods), sauerkraut, kefir, yogurt, etc., which somewhat defeats the probiotic value. If in the U.S., you might try Whole Foods for some raw, fermented foods such as kimchi. Water kefir is also quite simple and can be--

Thanks I would love to get testing, though I'm very poor. I sometimes get the feeling that there's a lot wrong with me - my gut must be in some really bad health I think. I guess maybe I can go kinda low carb, but not too low carb? I am taking probiotics. I started a few months ago with higher dosage. That's when I started getting stomach cramps for a few weeks... but it's also when I ran out of magnesium, so I don't know what it was. I take both now (plus omega 3's) so... I guess I will start with these steps and see how I feel.

Thanks - I guess my problem was knowing how low carb or not to go. Will rice make me crave? Maybe not, as long as I'm not having sugary stuff with it. Or cheese. And yogurt? Cream, or butter? Maybe I'll have those too. Maybe oats? I wasn't sure if too many carbs or dairy would make things worse, or if going really low carb would make it worse! So.... hmm.

Thanks! I think I will take out cheese for awhile. I'm wondering though, if I do have a cheat day next week, I'll have the rest of the cheese I have then, and also may see if it affects me the same way. I do take probitics every day... I wonder if they're even helping?? And I just started eating more kim chi. Does that count?

Thank you. I don't know of any paleo dieticians here. But one thought is that if the ED clinic doesn't work for me, I can talk to the nutritionist where I get 'regular' therapy. And talk to my therapist about this stuff, too. The therapist there is more open about these things (I've talked to her a few times in the past). Oh and I just started a little bit of weight training! Not a lot, but I already feel better and healthier. :)

Thank you. ^_^ I think a cheat day might be a good idea, but ONLY if I find things that I don't react too badly to. Like sushi!! :) But if I have GF pasta and cookies and so on, it restarts this cycle of cravings again. So I actually feel worse in the long run. But I know what you mean about orthorexia - hopefully if I have things like sushi, some sugar in my coffee sometimes, and other things I've learned don't spark intense cravings, then I won't feel deprived and I'll learn how to not be all or nothing and have to have 'pure' foods. Our bodies are good at detoxifying...to an extent.

I have no experience with disordered eating myself, but it seems restrictive diets (like paleo and veganism) are oft-considered 'healthy' diets to recover from EDs with. Though it seems it's simply replacing one compulsion with another without addressing the underlying core problem.

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Answers

I have been there too, Little Rain. I suffered from anorexia, bulimia, and binge eating for a little under a decade. I also found that my idea of nutrition clashed with the dieticians I saw. Could you find a paleo dietician? The sad thing is that most dieticians are educated about the SAD diet and don't understand what "health" is. In my experience, keeping to a 80/20 diet helped (s) me. I eat paleo for most of my meals, but I force myself to eat something that I used to see as "forbidden" like a piece of cheesecake or french fries. This has helped me have a healthier attitude towards food. I also recommend that you stay way clear of intermittent fasting, which can be a springboard to anorexia again--that is just my opinion. Also, I would stay clear of tracking macros or calories b/c that can lead to obsessive behavior (again, I am using my own experience). I would also start a strength training routine--it helped me change my relationship to my body: it helped me focus on getting stronger not thinner or lighter on the scale. You can get through this, but if you don't like your doctors, you have every right to change them. Doctors don't always know best, but you have to be honest with yourself also about WHY you want to go paleo. It shouldn't be for weight loss, but, as others have stated, to heal their gut or to get better energy.

Thank you. I don't know of any paleo dieticians here. But one thought is that if the ED clinic doesn't work for me, I can talk to the nutritionist where I get 'regular' therapy. And talk to my therapist about this stuff, too. The therapist there is more open about these things (I've talked to her a few times in the past). Oh and I just started a little bit of weight training! Not a lot, but I already feel better and healthier. :)

I just want to say I've been there and to some degree still am. The standard protocol for ED recovery stands in harsh contrast to an eating plan like Paleo. I find Paleo has been really helpful for my own ED in some ways - stable weight, no more binging/purging - but probably not in other ways - has undoubtedly strengthened the orthorexia aspect. My reason for going Paleo was to deal with chronic digestive issues. My therapist would prefer I wasn't Paleo because it does fuel the eating disorder to some degree, but understands my motivation for eating this way.

Maybe a good balance for you would be to eat 80/20 - eat Paleo most of the time but give yourself one cheat day or cheat meal a week - a pasta dinner or whatever. Just to kind of challenge the ED and give yourself some of those foods you miss.

Bottom line is you need to find a path that makes sense for you, and recovery will look different for everyone. Your family may not love it, but if Paleo is what keeps you sane and healthy and happier, that's what counts. Personally I agree with you - sugar/wheat is intensely addictive for me, so why give myself the monumental challenge everyday of eating it and then having to stop after 1 bowl of cereal, cookie etc? Much easier for me to just avoid it altogether. And since I'm eating a much higher fat, higher protein diet than SAD, I'm more satisfied after my meals then I would be after a high-carb, low-fat meal which only leaves me wanting more.

Thank you. ^_^ I think a cheat day might be a good idea, but ONLY if I find things that I don't react too badly to. Like sushi!! :) But if I have GF pasta and cookies and so on, it restarts this cycle of cravings again. So I actually feel worse in the long run. But I know what you mean about orthorexia - hopefully if I have things like sushi, some sugar in my coffee sometimes, and other things I've learned don't spark intense cravings, then I won't feel deprived and I'll learn how to not be all or nothing and have to have 'pure' foods. Our bodies are good at detoxifying...to an extent.

My opinion: definitely cut out foods that trigger cravings and binges. Wheat, sugar, cheese, nuts (if these are an issue - they are for a lot of people), 'snack foods'.

However, you shouldn't go crazy strict super-low-carb paleo, or do fasting, at this point in your recovery. Once you've gotten your psych issues under control and are in a healthier pattern, you will want to experiment with macros for weight loss, but your body fat is just a symptom of your overall health, and shouldn't be the focus now.

Thanks - I guess my problem was knowing how low carb or not to go. Will rice make me crave? Maybe not, as long as I'm not having sugary stuff with it. Or cheese. And yogurt? Cream, or butter? Maybe I'll have those too. Maybe oats? I wasn't sure if too many carbs or dairy would make things worse, or if going really low carb would make it worse! So.... hmm.

Starches without much added salt, fat, sweet and/or 'crunch' don't seem to induce binge behavior for most people who struggle with it. :) Trial and error, though. If you find a certain food is causing you to overindulge, you know it's not worth keeping around. I'd stick to unsweetened/high protein varieties of yogurt. Since you would like to lose weight, do not pour cream and butter on everything, but I don't see why you shouldn't use them in recipes. Cooking every day is a really great way to get into a healthy, normal pattern with food.

You may find that low-carb is best for you ultimately, at least when trying to lose significant weight. But with an active ED I think it's dangerous to jump into any sort of extreme, restrictive, challenging new diet.

Cheese sounds very much like a first good try for elimination if it is as triggering as you'd thought. (No bloating/cravings, or significantly less, could be a very large difference in quality of daily life.). Grains next, then legumes, or vice versatile, based upon which you'd have less digestion issues with, perhaps?

(If still cravings after eliminating the cheese, have you tried unsweetened or very dark (85%+) chocolate, preferably homemade or very clean of additives) to prevent them? Also, mineral dediciencies in diet seem to cause by far the most cravings. Worth a look at Mg, Zn, Cu, Ca, Se, etc....)

Second researching gut health issues, and trying ferments like water kefir.

Some observations -- The Americans seem to have quite a bit of stigma around EDs. In some Eastern cultures, this (fluctuating patterns in eating) might be seen as an attempt to establish standards--to be able to judge properly what is correct or incorrect.

The Americans (and many other cultures) also ironically seem to have the most "peer pressure" surrounding not having standards regarding food. E.g."Just eat everything in moderation & stop thinking so much about it". This is similar to the common American/(general Western) psychology methods of treating the symptom ("Your attempt to understand/have personal insight into standards is causing you problems with patterns in eating. So, instead of establishing true standards, you ought to just ignore trying to understand/establish standards in your eating pattern. That will make the symptoms go away (but it will never make you understand).") Very potentially pseudoscientific and counterproductive.

Thanks! I think I will take out cheese for awhile. I'm wondering though, if I do have a cheat day next week, I'll have the rest of the cheese I have then, and also may see if it affects me the same way. I do take probitics every day... I wonder if they're even helping?? And I just started eating more kim chi. Does that count?

(Ah, weight training and body vitality can truly make a very large difference, even on an unclean-diet. (From reading some other comments, seems like an interesting thing to explore/do meanwhile while sorting out diet/health.))

Kim chi and other fermented foods will all have beneficial bacteria/enzymes so long as they're unpasteurized (Pasteurization supposedly kills all beneficial bacteria and destroys many beneficial enzymes and digestively helpful constituents). Best if they contain the "mother". Many commercial preparations pasteurize kimchi(though this is much more commonly raw than other foods), sauerkraut, kefir, yogurt, etc., which somewhat defeats the probiotic value. If in the U.S., you might try Whole Foods for some raw, fermented foods such as kimchi. Water kefir is also quite simple and can be--

I am sorry I won't be able to answer most of your questions since I am not a trained professional - and only a trained professional can do it.

However, I can offer you some hope.

I used to be have intense cravings for sweets, especially chocolate. The cravings were so strong, so severe and so overwhelming that I could not control myself. I would go to the nearest store and buy a chocolate cake just to devour it and then feel sick afterwards.

It is no longer an issue for me. As a matter of fact, I don't even like chocolate anymore. I cannot believe I am saying this - me, a former chocoholic who could not pass anything that even remotely reminded me of chocolate - I no longer consume it, along with baked goods and cheese.

So... how did this happen? What lead to this remarkable transformation?

I was diagnosed (actually, I diagnosed myself, and then went for testing, and brought the test results to my doctors and they confirmed the diagnosis) with:

Candida Albicans (I officially have it because I have antibodies in my blood - pretty scary)

and this is in addition to my chronic gastritis, pancreatitis and nonalcoholic fatty liver. And I am sure I am not even half through with my recovery. Great, isn't it?

In the past, I thought it was all in my head and if I would apply some psychological tricks, like cognitive behavioral therapy, I would stop craving sweets. Now I know, it was NOT all in my head. It was in my gut.

My advice to you:

work closely with your doctors and therapists, follow their recommendations

get some testing done, even if you have to pay for it out of your pocket. Not sure what you might have but intense sugar cravings may indicate any of my conditions. Get a complete stool testing done - make sure it is a genetic test by Metametrix of Genova, they are not that expensive.

Thanks I would love to get testing, though I'm very poor. I sometimes get the feeling that there's a lot wrong with me - my gut must be in some really bad health I think. I guess maybe I can go kinda low carb, but not too low carb? I am taking probiotics. I started a few months ago with higher dosage. That's when I started getting stomach cramps for a few weeks... but it's also when I ran out of magnesium, so I don't know what it was. I take both now (plus omega 3's) so... I guess I will start with these steps and see how I feel.

Low-carb and not low-carb seems very...fluid, but if it's doable, you might try PHD, or sushi/white rice if low-carb paleo all at once is untenable for any number of reasons. Sushi rice might be less provocative than oats/grains. And, you can also transition to lower carb Paleo from PHD slowly, or experimentally. Feet-first low-carb is another possibly beneficial experiment if your gut health really is being negatively affected by carbs, but only so long as it is tenable, or has a fallback, such as PHD.

As a side note -- many people seem to find that true ferments speed gut health recovery tremeendously.
There are a few investigations into the effectiveness of probiotic supplements which show that many are at least somewhat ineffective, and even a high-quality probiotic is far from the organisms/cm3 in a true ferment (if I recall not incorrectly, this is around 1 billion + : 2-4 million; ferments : supplements.)